Insurance billing for solo counselors, group therapy practices, psychological testing providers and telehealth-only practices.
A full caseload does not produce a full deposit. Across 7,200 behavioral health claims we audited, 18% of 90837 claims had documented session time under 53 minutes, claims sent to the medical plan instead of the behavioral health carve-out caused 12% of behavioral health denials, and solo therapists carried a median 41 days in AR, against 29 for group practices. Luxen works eligibility, coding, claims, denials and patient balances inside the system your clinicians already chart in.
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Therapist billing services run the insurance side of a therapy practice: eligibility, coding, claim submission, denials, appeals and patient balances for licensed counselors, social workers and marriage and family therapists. Across 38 client practices, first-pass denial rate fell from 14.2% to 6.1% within 90 days of onboarding.
Luxen bills for solo private practices run by an LCSW, LMFT, LPC or LPCC, for group practices with a mixed roster of licensed clinicians and supervised associates, and for counseling centers that carry both insurance and self-pay clients. We also bill psychological and neuropsychological testing providers, couples and family therapy practices, play and pediatric therapy practices, school and community mental health programs, and telehealth-only practices licensed across several states.
Billing differs by practice shape. A solo clinician lives or dies on front-end accuracy, because nobody is behind them to catch a wrong payer ID. A group practice lives or dies on the rendering provider field, since one clinician whose enrollment is not yet effective can put a week of sessions at risk. Testing providers live on unit math across 96130 to 96139. Telehealth practices live on place of service and state licensure.
Most therapy practices bill more than one service line: individual and group psychotherapy, family sessions with and without the client present, diagnostic evaluations, crisis sessions, psychological testing, and, where a prescriber sits in the group, medication management visits with psychotherapy add-on codes. Our full service medical billing team owns all of them on one work queue.
Dollar figures below are CY2026 national non-facility Medicare amounts, computed from the published total RVUs in the CY2026 Relative Value File at the nonqualifying APM conversion factor of $33.4009. A clinical social worker, MFT or mental health counselor is paid 75% of those amounts; commercial contracts vary. The point is the gap between the two codes or the two outcomes, not the absolute number.
| Scenario | Codes | What goes wrong | $ at stake per claim | Luxen audit finding |
|---|---|---|---|---|
| A 60 minute session billed with a shorter note | 90837, 90834 | Documented time does not reach 53 minutes, so the claim is downcoded on review or recouped on audit | $53.10 | 18% of 90837 claims had documented session time under 53 minutes, across 7,200 behavioral health claims |
| Claim routed to the medical plan on the card | 90834, 90791 | The behavioral benefit sits with a separate administrator, so the claim denies and the filing clock keeps running | $113.90 | Claims sent to the medical plan instead of the behavioral health carve-out caused 12% of behavioral health denials |
| Tele-therapy billed with the wrong place of service | 90837, POS 10 | POS 02 on a session delivered to the client at home pays the facility rate instead of the non-facility rate | $31.73 | Telehealth place-of-service and modifier errors caused 15% of behavioral health telehealth denials |
| A new clinician starts seeing clients before the payer adds them | 90791, 90834 | The rendering provider is not on file, the claim denies, and nobody rebills it once the effective date lands | $173.35 | New clinicians waited a median 96 days to go in-network with commercial payers |
| Denied sessions closed without rework | 90853, 90847 | No person owns the denial queue, so corrected claims and appeals are never filed | $109.55 | 19% of denied claims were never reworked or appealed |
Every figure below is the CY2026 national non-facility and facility amount, total RVU multiplied by the nonqualifying APM conversion factor of $33.4009. The qualifying APM conversion factor is $33.5675, which moves these numbers by cents, not dollars. The therapist column applies the 75% of the psychologist amount that Medicare pays a clinical social worker, marriage and family therapist or mental health counselor.
| Code | Service | Non-facility | Facility | Therapist allowed at 75% |
|---|---|---|---|---|
| 90791 | Diagnostic evaluation | $173.35 | $137.28 | $130.01 |
| 90832 | Psychotherapy, 30 minutes | $85.84 | $69.47 | $64.38 |
| 90834 | Psychotherapy, 45 minutes | $113.90 | $91.85 | $85.43 |
| 90837 | Psychotherapy, 60 minutes | $167.00 | $135.27 | $125.25 |
| 90846 | Family, client not present | $105.88 | $99.20 | $79.41 |
| 90847 | Family, client present | $109.55 | $102.87 | $82.16 |
| 90853 | Group psychotherapy | $30.39 | $24.38 | $22.79 |
| 90785 | Interactive complexity add-on | $14.70 | $11.69 | $11.03 |
| 90839 | Crisis psychotherapy, first 60 minutes | $160.32 | $129.60 | $120.24 |
CMS publishes the descriptors as 30, 45 and 60 minutes and leaves the minute ranges to the CPT time convention, which is where 16 to 37, 38 to 52 and 53 minutes and over come from. State Medicaid programs put the same ranges in writing: Washington Health Care Authority sets 90832 at 16 to 37 minutes, 90834 at 38 to 52, and 90837 at 53 minutes and above. Two practical consequences follow. A note that records a 50 minute session does not support 90837, and a note that records no stop time supports nothing at all. Our certified coders check documented time against the billed code before the claim leaves, not after a payer asks for records.
The defining structural fact of therapy billing is that the behavioral benefit is often not administered by the plan printed on the card. A separate administrator holds the network, the authorization rules, the payer ID and the appeal address. Billing the medical plan produces a clean-looking claim that denies, and the filing window keeps running while the practice waits.
Three checks settle it before the first session. Verify the behavioral benefit separately from the medical benefit, capture the behavioral payer ID rather than the one on the card, and confirm which entity holds the clinician's contract, because a practice can be in-network medically and out-of-network behaviorally at the same payer. Medicaid makes this structural rather than occasional. Connecticut carves the Medicaid behavioral benefit out to a separate partnership with its own authorizations, claim path and appeal route, which we handle on our Connecticut billing desk. Several states instead run county or regional behavioral plans, each with its own credentialing queue.
Authorization rules move too. Minnesota pulled outpatient mental health and substance use treatment out of prior authorization in January 2026, which changes what a front office should be doing before a visit rather than after a denial, and our Minnesota billing team rebuilt the pre-visit checklist around it. Our eligibility and prior authorization work is the step that catches both of these before a clinician sits down with a client.
Medicare allows 12 months from the date of service under 42 CFR 424.44, and a timely filing denial is not an initial determination, so it cannot be appealed. Commercial behavioral plans are often far shorter, and the clock does not restart because the first claim went to the wrong administrator. In the practices we review, 27% of total AR sits past 90 days, 19% of denied claims were never reworked or appealed, and eligibility and coverage errors caused 24% of denials. Appeals filed by Luxen were overturned 68% of the time, which is the whole argument for denials and AR recovery having a named owner instead of being whoever has a free afternoon.
Telehealth is where competitor pages are most often out of date, and where a therapy practice loses the most money to a field that takes one second to set correctly. Two changes matter for 2026.
POS 10 means telehealth provided in the patient's home. POS 02 means telehealth provided anywhere else. Since January 1, 2024, Medicare pays claims for telehealth delivered to a patient at home at the non-facility rate, so for most tele-therapy POS 10 is both correct and the higher-paying choice. On 90837 the gap between the non-facility and facility amount is $31.73 a session, which is a four-figure annual difference for one full-time clinician. Place-of-service and modifier errors caused 15% of behavioral health telehealth denials in our audit.
The geographic and site restrictions on behavioral telehealth were removed permanently by the Consolidated Appropriations Act, 2021, and two-way audio-only technology is permitted for behavioral health telehealth, with the patient in their home. The in-person visit requirement, the one that would force a face-to-face visit within six months before the first tele-mental-health service and every 12 months after, is not in effect. Section 6209 of the Consolidated Appropriations Act, 2026, enacted February 3, 2026, moved it to January 1, 2028, and moved the general telehealth flexibilities and audio-only payment to December 31, 2027. CMS says the same thing in its February 2026 telehealth FAQ. Several CMS booklets still carry the older date, which is why practices keep being told to schedule a visit that no rule currently requires.
State rules sit on top of the federal ones. Hawaii requires telehealth to be reimbursed at parity with in-person care, and pays audio-only mental health in the patient's home at 80% subject to a prior in-person or video visit inside six months, which our Hawaii billing team tracks per payer. Also new for 2026: 90849 joined the Medicare telehealth list, and virtual direct supervision by real-time audio-video became permanent, audio-only excluded.
The CPT time convention puts 90834 at 38 to 52 minutes and 90837 at 53 minutes and above, and Washington Health Care Authority publishes those ranges in its reporting instructions. A 50 minute hour is 90834. The difference is $53.10 per session at CY2026 national non-facility rates, payable in either direction: billed low it is lost revenue, billed high it is a recoupment. In our audit, 18% of 90837 claims had documented session time under 53 minutes, across 7,200 behavioral health claims.
That limitation was phased out by section 102 of the Medicare Improvements for Patients and Providers Act of 2008 and has been gone since 2014, when 100% of expenses became recognized. The client pays the standard 20% coinsurance after the 2026 Part B deductible of $283. Quoting the old number costs twice, once in clients who decline care and once in balances nobody collects, and practices lost 3.1% of collections to patient balances written off before a second statement.
Not currently. Section 6209 of the Consolidated Appropriations Act, 2026 moved the tele-mental-health in-person visit requirement to January 1, 2028, and CMS confirms it in the February 2026 telehealth FAQ. Cancelling or converting sessions to satisfy a requirement that is not in force costs $125.25 in allowed amount every time a 60 minute Medicare session does not happen. Telehealth place-of-service and modifier errors caused 15% of behavioral health telehealth denials.
Medicare does not cover services furnished incident to a therapist's own professional services, and contractor guidance is explicit that individuals not licensed or authorized under state law to provide psychological services may not provide them under the incident-to provision. Every such session is a recoupment candidate at $85.43 to $125.25 in allowed amount. New clinicians waited a median 96 days to go in-network with commercial payers, so the fix is earlier enrollment, not creative billing.
For behavioral health it often does not. The behavioral benefit is frequently administered by a separate entity with its own payer ID, authorization rules and filing window, and Medicaid programs in several states carve it out entirely. Claims sent to the medical plan instead of the behavioral health carve-out caused 12% of behavioral health denials, and eligibility and coverage errors caused 24% of denials overall.
They are priced differently and treated differently. Both describe 50 minutes of family psychotherapy, but 90846 is the session without the client present and carries a restricted coverage status in the CY2026 relative value file, while 90847 is actively priced at $109.55 non-facility. Billing the wrong one, or assuming coverage, turns a delivered session into a write-off. Coding and modifier errors caused 21% of denials in our claim audit.
Sources for the rules above are listed at the end of this page.
We run the revenue cycle from eligibility to zero balance inside the practice management system you already use. How full-service billing works.
Certified coders review charges against your documentation and payer rules before the claim goes out, so the denial is prevented rather than appealed. Medical coding.
Aged and denied claims are worked to resolution, then the upstream cause is fixed so the same claims stop coming back. Denials and AR recovery.
Benefits are verified and authorizations secured before the appointment, which is the cheapest place in the cycle to stop a denial. Eligibility and prior authorization.
Statements, balance questions and payment plans are handled by the same team that worked the claim. Patient billing.
Payer enrollment and re-credentialing are tracked through to approval, so a lapsed credential never quietly stops payment. Credentialing.
A HIPAA-trained front-office assistant working inside your EHR on calls, scheduling, intake and referrals, alongside the billing team. Medical virtual assistant.
Therapy practices run on their own software stack, and we work inside it. We bill daily in TherapyNotes, SimplePractice, Valant, TheraNest and Ensora, Qualifacts CareLogic, AdvancedMD, Tebra, athenahealth, Alleva, Sessions Health and Jane, and we work claims through Office Ally and Availity. Where a practice tracks outcomes in a measurement-based care tool, we pull session completion from there rather than asking clinicians to re-enter anything. Nothing migrates. No practice changes its EHR, its note templates or its scheduling to work with us: we take credentials under a signed BAA, learn your chart flow, and bill from the record your clinicians already complete. 38% of practice managers had changed EHR or practice management system in the past five years, and of those, 71% said collections dipped for at least six months after the switch. We are not going to ask you to do that again.
2 weeks
from a signed BAA to our team working your claims
About 3 weeks
to the first recovered payments on aged AR
20+ years
combined billing and coding experience
Figures below come from the Luxen claim audit dataset of 61,400 claims audited between January 2025 and June 2026, and the Luxen billing reviews dataset of 410 practice billing reviews over the same period.
Claims were being submitted under the wrong rendering clinician when therapists changed locations or payer participation status. Luxen mapped every provider and reduced clinician-related rejections from 12.8% to 2.6%.
Practice Administrator, multidisciplinary therapy practice
Completed appointments could remain unbilled for more than a week while signed notes sat in separate queues. Luxen created a daily completion report, reducing claim lag from 8.7 days to 1.9.
Clinical Operations Director, outpatient therapist network
Full engagements are written up in our dental practice case study and our ambulance billing case study.
The largest regulatory change in therapist billing in a decade is the one the ranking pages do not mention. Section 4121 of Division FF of the Consolidated Appropriations Act, 2023 added MFT and MHC services to Medicare Part B for services furnished on or after January 1, 2024. MFTs and MHCs now enroll and bill Medicare independently. CMS confirms that addiction, alcohol and drug counselors who meet the MHC requirements may enroll as MHCs. The qualification floor is a master's or doctoral degree that qualifies the clinician for state licensure plus at least two years or 3,000 hours of post-degree supervised clinical experience.
These two percentages get conflated constantly, and the difference is real money. The 75% is the provider-type reduction: a clinical social worker, MFT or mental health counselor is paid 75% of the amount a psychologist would receive. The 80% is the ordinary Part B share, with 20% falling to the patient after the 2026 deductible of $283. Stacked on a 60 minute session in 2026: $167.00 national non-facility, times 75% gives a $125.25 allowed amount, Medicare pays $100.20 and the client owes $25.05. A clinical psychologist is paid at 100% of the fee schedule amount when accepting assignment.
Medicare does not cover services provided incident to a therapist's own professional services, and individuals not licensed or otherwise authorized by state law to provide psychological services may not provide them under the incident-to provision at all. In plain terms, a supervised pre-licensed associate's sessions are not billable to Medicare under the supervisor's NPI. Commercial payers differ clinician by clinician and contract by contract. Getting each licensed clinician enrolled is the real lever: new clinicians waited a median 96 days to go in-network with commercial payers, and credentialing lapses delayed payment for 1 in 12 providers added in the prior year, which is why credentialing sits at the front of onboarding rather than the end.
Therapy carries more self-pay volume than almost any other outpatient specialty, which puts a federal requirement in front of practices that never think of themselves as billing operations.
Since January 1, 2022, under 45 CFR 149.610, an uninsured or self-pay client is entitled to a written good faith estimate. It must carry the client's name and date of birth, a plain-language description of the primary service, an itemized list grouped by provider, the expected service codes, diagnosis codes and charges, and the provider's NPI, tax ID and location. Timing is fixed: one business day after scheduling when the service is booked at least three business days out, three business days after scheduling when it is booked at least ten business days out, and three business days after a request.
If billed charges exceed the estimate for a given provider by $400 or more, the client may take it to the patient-provider dispute resolution process under 45 CFR 149.620, within 120 calendar days of the initial bill. For a weekly therapy client, $400 is four sessions, so a recurring-session estimate written loosely is a dispute waiting to happen. Note also that the No Surprises balance-billing protections cover emergency care, certain ancillary services at in-network facilities and air ambulance; a routine out-of-network therapy session is not among the protected categories, which is exactly why the estimate matters.
On the collection side, plain-language statements plus text reminders raised patient collections 22% across 14 practices, and practices lost 3.1% of collections to patient balances written off before a second statement. There is no federal definition of a superbill, so out-of-network clients are working with whatever itemized document the practice hands them; for Medicare the equivalent mechanism is Form CMS-1490S.
3% to 6% of collections
Luxen's pricing generally falls between 3% and 6% of collections, depending on claim volume, specialty, payer mix, and how much of the revenue cycle your practice hands over.
Higher-volume practices usually land toward the lower end. Smaller or more complex practices land higher because there is more work per account. There is no setup fee and no exit fee, and the agreement runs month to month with 30 days notice.
A lower fee attached to weak billing is still expensive. The number that matters is what your collections do after you hire someone.
Luxen charges 3% to 6% of collections. Where a practice lands in that range depends on claim volume, payer mix and how much self-pay and out-of-network work sits on top of the insurance book. There is no setup fee, no exit fee, and the agreement is month to month with 30 days notice.
At 5% of collections the fee is $39,000 a year, or $3,250 a month. Fully loaded in-house billing cost 7.9% of collections for practices under $2M, across 96 practices that shared payroll data, which on $780,000 is $61,620. The gap is $22,620 a year before any recovery effect. A solo clinician collecting $130,000 sits at the top of the range: 6% is $7,800 a year, or $650 a month.
| Cost line | In-house | Luxen at 5% |
|---|---|---|
| Billing labor, fully loaded | 7.9% of collections, $61,620 | Included in the fee |
| Clearinghouse and claim software | Practice pays | Included in the fee |
| Cover for vacation, illness and turnover | Practice absorbs it; open biller roles took a median 67 days to fill | Included in the fee |
| Denial and appeal ownership | Often unassigned; 42% of practice managers said nobody owns denial follow-up full time | Named owner per account |
| Credentialing and enrollment upkeep | Usually the practice manager, between other work | Included in the fee |
| Setup and exit fees | Recruiting and training cost | None |
| Annual cost on $780,000 collected | $61,620 | $39,000 |
The recovery side is what actually pays for the change. Across 38 client practices, median days in AR dropped from 54 to 33 within 120 days, and every 10 days removed from AR released a median $41,000 in cash for practices collecting $1.5M to $3M a year.
Ask questions a generalist cannot answer. Which entity administers the behavioral benefit for my three largest payers, and what is the payer ID for each. How do you check documented session time against 90834 and 90837 before submission. What place of service and modifier do you use for a session delivered to a client at home, and why. Who owns my denial queue by name, and what is your appeal overturn rate. How do you handle a clinician whose enrollment is not yet effective. Do you bill 96130 to 96139 testing units, and how do you count them. What happens to my self-pay clients and their good faith estimates. Is the fee on collections or on charges.
Then ask for the reporting you will get monthly. Practices that reviewed AR ageing monthly carried 12 fewer days in AR, and 63% of practice managers could not name their top three denial reasons. If a prospective partner cannot show you those three reasons for a practice like yours, they are not measuring them. You can compare medical billing companies by state as well.
| Partner type | Behavioral coding depth | Carve-out and payer routing | Coverage when someone leaves | Commitment |
|---|---|---|---|---|
| In-house biller | Varies with one person | Learned per payer over years | None; roles took a median 67 days to fill | Payroll |
| Generalist billing company | Broad, rarely psychotherapy-specific | Often bills the card on file | Yes | Usually annual |
| Specialty behavioral company | Deep | Yes | Yes | Varies |
| EHR vendor RCM | Tied to that platform | Limited outside it | Yes | Tied to the software contract |
| Luxen | Certified coders, 20+ years combined experience | Verified per payer before the first session | Yes, named owner per account | Month to month, 30 days notice, no setup or exit fee |
A 30-minute look at your AR ageing, denial reasons and payer mix. You leave knowing what is recoverable, what we would work first and what it would cost.
We sign a business associate agreement before anyone touches your system. Your named team then works inside the practice management system and clearinghouse you already use. Nothing is migrated, and claims are being worked within two weeks of the signed BAA.
Aged and denied claims come first because that is revenue you have already earned. Most practices see the first recovered payments inside three weeks.
Once the backlog is moving, we take over the agreed part of the daily cycle: eligibility, coding review, submission, posting, denials and patient balances.
You know who owns your claims. The team works inside the practice management system and EHR you already run, with no migration.
Claims are coded by certified coders against your documentation and payer rules. Automation handles the repetitive checks so people spend their time on the claims that need judgment.
We sign a business associate agreement before accessing protected health information, and access is limited to the named people on your account.
We look at your AR ageing, volume, payer mix and denial profile first, then tell you what we believe is recoverable and what it would cost.
A billing company is a poor fit if you are not willing to share visibility into your billing, if the vendor uses a rotating pool of people who never learn your practice, or if it cannot explain why your claims are being denied. Be wary of anyone promising large collection increases before they have seen your AR ageing. The right partner makes your revenue cycle more visible, not less.
Luxen charges 3% to 6% of collections, with no setup fee, no exit fee and 30 days notice. For comparison, fully loaded in-house billing cost 7.9% of collections for practices under $2M across 96 practices that shared payroll data. A six-clinician group collecting $780,000 a year pays $39,000 at 5%, against $61,620 in-house.
Yes. Marriage and family therapists and mental health counselors have been able to enroll and bill Medicare independently for services furnished on or after January 1, 2024, under section 4121 of Division FF of the Consolidated Appropriations Act, 2023. A clinical social worker, MFT or MHC is paid 75% of the amount a psychologist would receive, and Medicare then pays 80% of that after the 2026 deductible of $283.
Session length, and the documentation that proves it. 90834 covers 38 to 52 minutes and 90837 covers 53 minutes and above under the CPT time convention, which state Medicaid reporting instructions publish as written ranges. At CY2026 national non-facility rates the difference is $113.90 against $167.00, so a note without a stop time puts $53.10 a session at risk.
No. We bill inside TherapyNotes, SimplePractice, Valant, TheraNest, Ensora, Qualifacts CareLogic, AdvancedMD, Tebra, athenahealth and others, and nothing migrates. It takes about two weeks from a signed BAA to working claims, with first recovered payments in about three weeks. That matters because 71% of the practice managers who had changed systems said collections dipped for at least six months afterward.
Not right now. Section 6209 of the Consolidated Appropriations Act, 2026 moved the tele-mental-health in-person visit requirement to January 1, 2028, and CMS confirmed it in its February 2026 telehealth FAQ. Audio-only is permitted for behavioral health telehealth with the client at home, and a session delivered to a client at home is billed with place of service 10, which Medicare pays at the non-facility rate.
Thirty minutes, no deck and no fee. We look at what is sitting past 90 days and where your denials cluster, and you leave knowing what is recoverable, what we would work first, and what it would cost.
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